=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720829096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTIONS COUNSELING CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 MILL ST
-----------------------------------------------------
City | MILESBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16853-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-357-2400
-----------------------------------------------------
Fax | 814-357-7740
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8988
-----------------------------------------------------
City | MILESBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16853-8988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-357-2400
-----------------------------------------------------
Fax | 814-357-7740
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MELISSA SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-357-2400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------